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Open AccessArticle

Long-Term Effects of Air Pollutants on Mortality Risk in Patients with End-Stage Renal Disease

1
Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul 08826, Korea
2
Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do 10326, Korea
3
Department of Internal Medicine, Dongguk University College of Medicine, Gyeongsangbuk-do 38066, Korea
4
Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
5
Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Korea
6
Institute of Health and Environment, Seoul National University, Seoul 08826, Korea
7
Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu 41566, Korea
8
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul 07061, Korea
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
These authors are mentioned in Acknowledgments.
Int. J. Environ. Res. Public Health 2020, 17(2), 546; https://doi.org/10.3390/ijerph17020546
Received: 17 December 2019 / Revised: 12 January 2020 / Accepted: 13 January 2020 / Published: 15 January 2020
(This article belongs to the Section Environmental Health)
Long-term exposure to air pollutants significantly increases the morbidity and mortality associated with various diseases. However, little is known about the relationship between air pollutants and end-stage renal disease (ESRD)-related mortality. A total of 5041 patients who started dialysis between 2008 and 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease (CRC-ESRD) cohort study. We assigned a daily mean concentration of air pollutants (PM10, NO2, and SO2) to each participant. Time-varying Cox models were used to investigate the relationship between air pollutants and mortality in ESRD patients. During the follow-up period (mean 4.18 years), 1475 deaths occurred among 5041 participants. We found a significant long-term relationship between mortality risk and PM10 (HR 1.33, CI 1.13–1.58), NO2 (HR 1.46, CI 1.10–1.95), and SO2 (HR 1.07, CI 1.03–1.11). Elderly patients and patients who lived in metropolitan areas had an increased risk associated with PM10. Elderly patients also had increased risks associated NO2 and SO2. Long-term exposure to air pollutants had negative effects on mortality in ESRD patients. These effects were prominent in elderly patients who lived in metropolitan areas, suggesting that ambient air pollution, in addition to traditional risk factors, is important for the survival of these patients. View Full-Text
Keywords: particulate matter; nitrogen dioxide; sulfur dioxide; ESRD; mortality particulate matter; nitrogen dioxide; sulfur dioxide; ESRD; mortality
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MDPI and ACS Style

Jung, J.; Park, J.Y.; Kim, Y.C.; Lee, H.; Kim, E.; Kim, Y.-L.; Kim, Y.S.; Lee, J.P.; Kim, H.; Clinical Research Center for End-Stage Renal Disease (CRC for ESRD) Investigators. Long-Term Effects of Air Pollutants on Mortality Risk in Patients with End-Stage Renal Disease. Int. J. Environ. Res. Public Health 2020, 17, 546.

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